Health Insurance Exchanges (HIX) were supposed to be a cornerstone of the Patient Protection and Affordable Healthcare Act of 2010, providing a way for individuals and groups to shop around and get affordable healthcare. Federal law mandates every state has to have a fully operational HIX in less than two years time. The act is designed to reduce overall spending on healthcare and raise taxation in a variety of ways by more than $400 billion over the first 10 years. To date, the federal government has awarded over $220 million to help the first 13 states design, build, and go live with their HIX, and over $600 million altogether.
So far so good, it seems. Reduce costs by introducing competition and provide more affordable healthcare for all—sounds great, right? Here’s the rub: Chaos abounds—as reported in the New York Times. States are taking a wait-and-see attitude for the results of the Supreme Court decision due over the summer and also for the results of the November 2011 general elections. On January 1, 2013, Obama will decide which states are advanced enough to run their own HIX, and which will be run by the federal government. Some states have backtracked. According to the New York Times article dated February 27:
“Wisconsin began planning an exchange last year under an executive order issued by Gov. Scott Walker, a Republican. But he repealed his own order last month and told state officials to stop work on the exchange.”
One has to wonder: where does this leave the country, the states, and individuals? Information technology will be the backbone of every exchange. The complexity of the computer systems needed to verify eligibility, enroll consumers, calculate subsidies and connect the exchange to state Medicaid agencies has slowed work in some states. To date, hundreds of millions of dollars have been spent on engaging consultants, designing, building, and testing systems, with more hundreds of millions—if not billions—still be to spent. Is this all money down the drain?
What lessons can we all learn from this? To me, it’s simple. The Affordable Healthcare Act really represents a need of a business to do things differently. This can translate to any organization, not just healthcare. If you mapped out your our own organization’s need to react to a requirement of change—since that’s what IT is really all about, enabling change—you would need to begin with an understanding of what changes are needed: Ensure stakeholders are in agreement and the project is funded; Gather business requirements and how they map to new or updated business processes; Determine what internal and external integration is needed; Pick the right technologies to get the project live on time, on budget; And of course, we need to meet (hopefully exceed) the overall business requirements, which means we have to have built-in analytics.